Factors That Impact the Timing and Removal of Gastrostomy Placement/Nissen Fundoplication in Children with Bronchopulmonary Dysplasia

Abstract

Objective The study aimed to identify factors that impact timing of gastrostomy placement/removal and Nissen fundoplication (NF) in infants with bronchopulmonary dysplasia (BPD).

Study Design Clinical data were reviewed retrospectively from patients recruited from the Johns Hopkins Bronchopulmonary Dysplasia Clinic (January 1, 2014–December 31, 2018).

Results Patients with gastrostomy tubes (GTs) placed in the neonatal intensive care unit (NICU) were older at discharge (p < 0.001) and less likely to have abnormal upper gastrointestinal series findings (p = 0.005) than those with GTs placed after NICU discharge. Patients with NF had lower mean gestational ages (p = 0.011), longer NICU stays (p = 0.019), more frequent home ventilation requirements (p = 0.005), and greater likelihood of pulmonary hypertension (p = 0.032) compared with those without. Median age of GT removal was 61.6 months. Patients with GTs were weaned from supplemental oxygen and/or home ventilation before GT removal (p < 0.001).

Conclusion Patients with GT/NF were more medically complex than those with GT alone. Patients were more likely to be weaned from home respiratory support before GT removal.

Key Points

• Patients with GT/NF were more medically complex than those with GT alone.

• Patients were more likely to be weaned from home respiratory support before GT removal.

• Patients with GTs placed in NICU were older at discharge and less likely to have abnormal upper gastrointestinal series result.

Keywords

bronchopulmonary dysplasia - gastrostomy - neonatal intensive care unit - prematurity - pulmonary hypertension - dysphagia

Authors' Contributions

K.N. contributed in the study design, methodology, chart review, data analysis, and drafted the initial manuscript. M.A.L.G. participated in the study design, methodology, chart review, oversight, and edited the manuscript. S.A.M.M. assisted in the study design, methodology, oversight, and edited the manuscript. J.M.C. helped with the study design, methodology, data gathering, formal analysis, drafted the initial manuscript, and supervised the project.

Publikationsverlauf

Eingereicht: 09. Dezember 2020

Angenommen: 19. April 2021

Artikel online veröffentlicht:
31. Mai 2021

• References

• 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
• 2 Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120 (06) 1337-1351
• 3 Morrow CB, McGrath-Morrow SA, Collaco JM. Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia. J Perinatol 2018; 38 (09) 1258-1265
• 4 Jadcherla SR, Khot T, Moore R, Malkar M, Gulati IK, Slaughter JL. Feeding methods at discharge predict long-term feeding and neurodevelopmental outcomes in preterm infants referred for gastrostomy evaluation. J Pediatr 2017; 181: 125-130.e1
• 5 Collaco JM, McGrath-Morrow SA. Respiratory phenotypes for preterm infants, children, and adults: bronchopulmonary dysplasia and more. Ann Am Thorac Soc 2018; 15 (05) 530-538
• 6 McGrath-Morrow SA, Hayashi M, Aherrera AD, Collaco JM. Respiratory outcomes of children with BPD and gastrostomy tubes during the first 2 years of life. Pediatr Pulmonol 2014; 49 (06) 537-543
• 7 Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Adv Neonatal Care 2011; 11 (02) 129-139
• 8 Mizuno K, Nishida Y, Taki M. et al. Infants with bronchopulmonary dysplasia suckle with weak pressures to maintain breathing during feeding. Pediatrics 2007; 120 (04) e1035-e1042
• 9 Matharu P, Cristea AI, Slaven JE, Becker S, Niehaus JZ. Feeding outcomes for infants with bronchopulmonary dysplasia discharged on nasogastric feeds. Am J Perinatol 2021; 38 (09) 897-900
• 10 Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of infants with home tube feeding: comparing nasogastric vs gastrostomy tubes. JPEN J Parenter Enteral Nutr 2017; 41 (08) 1380-1385
• 11 Warren MG, Do B, Das A. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Gastrostomy tube feeding in extremely low birthweight infants: frequency, associated comorbidities, and long-term outcomes. J Pediatr 2019; 214: 41-46.e5
• 12 Fukahori S, Yagi M, Ishii S. et al. Laparoscopic Nissen fundoplication mainly reduces the volume of acid reflux and potentially improves mucosal integrity up to the middle esophagus in neurologically impaired children detected by esophageal combined pH-multichannel intraluminal impedance measurements. J Pediatr Surg 2016; 51 (08) 1283-1287
• 13 Mahant S, Jovcevska V, Cohen E. Decision-making around gastrostomy-feeding in children with neurologic disabilities. Pediatrics 2011; 127 (06) e1471-e1481
• 14 Lefton-Greif MA. Pediatric dysphagia. Phys Med Rehabil Clin N Am 2008; 19 (04) 837-851 , ix ix.
• 15 Boesch RP, Daines C, Willging JP. et al. Advances in the diagnosis and management of chronic pulmonary aspiration in children. Eur Respir J 2006; 28 (04) 847-861
• 16 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3: 6
• 17 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. In: Vol 163. Access 2001 at: https://www.atsjournals.org/doi/full/10.1164/ajrccm.163.7.2011060
• 18 Abman SH, Hansmann G, Archer SL. et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Surgery and Anesthesia; and the American Thoracic Society. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 2015; 132 (21) 2037-2099
• 19 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996; 11 (02) 93-98
• 20 Greene NH, Greenberg RG, O'Brien SM. et al. Variation In gastrostomy tube placement in premature infants in the United States. Am J Perinatol 2018; DOI: 10.1055/s-0038-1676591.
• 21 Mowitz ME, Ayyagari R, Gao W, Zhao J, Mangili A, Sarda SP. Health care burden of bronchopulmonary dysplasia among extremely preterm infants. Front Pediatr 2019; 7: 510